Ankle sprain

Ankle sprains account for 85% of ligament injuries to this joint.¹ They are one of the most common injuries in sports and everyday life. The good news is that with proper care, most sprains heal completely. However, about 40% of people develop chronic instability if they don't treat their sprain properly.¹ This guide explains how to recognize a sprain, when to seek medical attention, and how to optimize your recovery. As physical therapists specializing in traumatic injuries, we assist patients with their rehabilitation on a daily basis. For an overview of conditions affecting this area, see our comprehensive guide to foot and ankle pain.

What exactly is an ankle sprain?

An ankle sprain occurs when you stretch or tear the ligaments that stabilize the joint. Ligaments are fibrous tissues that connect bones to each other. Lateral sprains, which affect the outer ligaments, account for 85% of cases^.

The ankle has three main external ligaments. The anterior talofibular ligament (ATFL) is most commonly injured. It resists when your foot turns inward. The calcaneofibular ligament (CFL) and posterior talofibular ligament (PTL) complete this stabilization system.

Ligaments do not contract like muscles. They heal more slowly. Their role is to prevent excessive movement of the joint. Unlike Achilles tendon tears, ankle sprains mainly affect ligament structures rather than tendons.

How does an ankle sprain occur?

A sprain occurs when your foot twists beyond its normal range of motion. The most common mechanism is inversion: your foot turns inward. This often happens when walking on uneven surfaces or landing awkwardly after a jump^.

Inversion causes 80 to 85% of ankle sprains. Eversion, when your foot turns outward, is less common. It injures the deltoid ligament on the inside of the ankle.

Common circumstances for sprains include:

• Walking on uneven ground
• Landing badly after a jump (especially during intense sporting activities)
• Changing direction quickly in a sport
• Falling from a step or sidewalk

Athletes who participate in sports involving repeated jumping, such as basketball or volleyball, are particularly at risk. These movements can also cause other injuries such as patellar tendinopathy in the knee.

An important point: a sprain always results from a clear traumatic event. If your pain developed gradually without an accident, you probably do not have a sprain. In this case, it could be Achilles tendinopathy or another chronic condition.

What are the different grades of ankle sprains?

Doctors classify sprains into three grades according to their severity. Grade I: mild stretching. Grade II: partial tear. Grade III: complete rupture of the ligament with joint instability.

The initial pain does not always reflect the severity. Some grade III sprains are less painful because the tear also breaks nerve fibers. A professional must assess your injury to determine the grade.

What are the symptoms of a sprain and how can you tell it apart from a fracture?

Typical symptoms include immediate pain after the injury, especially on the outside of the ankle. Swelling may appear quickly or within a few hours. You may also notice bruising, have difficulty walking, and feel instability.

Immediate symptoms include:

• Severe pain at the moment of injury
• Occasional "popping" or cracking sensation
• Difficulty putting weight on the foot

In the following hours, the following may occur:

• Progressive swelling
• Redness and warmth (approximately 48 hours)
• Bruising if the ligaments have bled

A minor sprain may not cause visible swelling. The bruise may migrate toward the foot due to gravity. If you feel pain under your foot, this could also indicate plantar fasciitis, especially if the pain is localized to the heel.

Your physical therapist will distinguish between a sprain and a fracture through clinical examination and the Ottawa rules. They will assess whether you need an X-ray. Specific bone pain, complete inability to walk, and severe swelling suggest a possible fracture.

You need an X-ray if you have:

• Pain directly on the bone when palpated
• The inability to take four steps
• Over 55 years of age

Go to the emergency room if you notice visible deformity, feel extreme pain, or lose mobility completely.

When to consult a physiotherapist for an ankle sprain?

Consult a physical therapist as soon as possible after the sprain, ideally within the first few days. You can make an appointment on the same day without seeing a doctor first. The first few days are crucial for optimizing healing.

You don't need a referral from a doctor in Quebec. Access is direct. If your physical therapist detects a complication, they will refer you to the appropriate professional. To learn more about the role of physical therapy, see our comprehensive guide.

During your first consultation, your physical therapist will:

• Assess the severity of the sprain (grade I, II, or III)
• Eliminates the risk of fractures
• Establishes an appropriate treatment plan

Consulting early on helps you avoid common mistakes: too much rest or returning to work too quickly. The first 48 to 72 hours are crucial.

How does physical therapy treat ankle sprains, and is it effective?

Physical therapy is recognized as an effective treatment for ankle sprains, with results supported by scientific research. Studies show an 80-90% success rate for treating ankle sprains with physical therapy. The combination of therapeutic exercises, manual therapy, and education is particularly effective in reducing pain and improving function.

The effectiveness of treatment depends on several factors: how early you seek treatment (the sooner, the better the results), how diligently you do your exercises at home, the severity of the sprain, residual stability, and proprioception. A comprehensive assessment allows the treatment to be tailored to your specific situation. Most patients see improvement within the first 1-2 weeks of treatment, with complete resolution in 4-8 weeks.

Physical therapy optimizes the healing environment. Your physical therapist eliminates factors that slow down healing: poor activity dosage, excessive fears, joint stiffness, and poor biomechanics.

Your body heals naturally. Inflammation is a normal and necessary process. Several factors can slow down healing:

• Concerns or fears
• An incorrect balance of activities
• Joint or muscle stiffness

Think of a plant. You can't make it grow faster by pulling on it. However, you can give it enough water and sunlight. To better understand the mechanisms of pain and how to manage it, see our guide to chronic pain.

Phase

Duration

Stability, return to function

Proprioception, functional exercises

Rehabilitation follows a structured progression in several phases, adapting the intensity and complexity of the exercises according to your individual response and your goals for returning to activity.

Your physical therapist will advise you on the use of crutches, a splint, or a bandage if necessary. Find out how physical therapy treats foot and ankle pain.

Do you have a sprained ankle? Make an appointment for a comprehensive assessment and personalized treatment plan.

What exercises help heal a sprained ankle?

Proprioception and balance exercises are essential for complete recovery. They train your brain to better control your ankle. Proprioceptive training reduces the risk of recurrence by 35 to 50%.

Proprioception allows your brain to know where your ankle is in space. Exercises on unstable surfaces and with your eyes closed gradually increase the difficulty. If you have ever suffered a calf strain, these balance exercises will also be beneficial in preventing recurrence.

Can you treat an ankle sprain yourself?

Self-treatment can relieve mild ankle sprains (ice, rest, gentle stretching). However, without proprioceptive rehabilitation, you risk chronic instability and recurrent sprains. Without an accurate diagnosis, you risk continuing to compensate or doing counterproductive exercises that delay healing.

The physical therapist assesses ligament stability and trains proprioception to prevent recurrence. An assessment helps identify the exact cause, eliminate red flags, and create a progressive treatment plan. The exercises are tailored to your specific condition, not generic.

Our approach: professional assessment + supervised home exercise program = better long-term results.

Are you unsure whether to self-treat or seek medical advice? Free 15-minute consultation to discuss your situation.

How long does recovery take and how can recurrence be prevented?

Healing time varies from 2 to 12 weeks depending on severity. A mild sprain (grade I) heals in 1 to 2 weeks. A moderate sprain (grade II) takes 3 to 6 weeks. A severe sprain (grade III) requires 6 to 12 weeks.

Several factors influence the duration:

• The severity of the injury (grade)
• The quality of your rehabilitation
• Your injury history

Don't base your return to sports solely on the absence of pain. Functional tests assess your strength, balance, and confidence. If you see no improvement after 10 days, consult a physical therapist.

Recovery times are comparable to other ligament injuries, but generally shorter than for a meniscus tear or fracture.

Complete your rehabilitation and do regular proprioception exercises. Approximately 40% of people develop chronic instability after an improperly treated sprain^.

Chronic instability gives the sensation that the ankle "gives way" easily. This condition can lead to repeated sprains and premature osteoarthritis, similar to the degenerative processes seen inknee osteoarthritis.

Effective prevention strategies:

• Complete your rehabilitation program all the way through
• Continue proprioception exercises after recovery
• Strengthen the muscles around the ankle, including the calf muscles, which play a stabilizing role.
• Warm up properly before exercising.
• Wear appropriate shoes with good support.

Taping or a brace can help with returning to sport. However, these aids are not a substitute for exercises. For athletes, a gradual return is essential, similar to the rehabilitation required after a knee sprain.

What are the key points to remember about ankle sprains?

An ankle sprain is a serious but treatable injury. With proper care and complete rehabilitation, you can regain ankle stability and prevent recurrence. Seek medical attention promptly, follow your exercise program, and don't stop too soon.

Remember that 40% of people develop chronic instability without proper rehabilitation. If you have suffered an ankle sprain, make an appointment with our team for a complete assessment.

For other foot and ankle conditions, see our guides on Morton's neuroma,hallux valgus, or metatarsalgia.

References

• Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment, and prevention of ankle sprains: update of an evidence-based clinical guideline. Br J Sports Med. 2018;52(15):956.